心包内处理肺静脉根部或切除部分左房在晚期肺癌手术中的应用

目的:探讨切开心包处理肺静脉或切除部分左心房对提高晚期肺癌患者的外科手术切除率及提高手术疗效的作用.方法:对21例晚期肺癌患者施行肺叶或全肺切除时,在心包内处理肺静脉或切除部分左心房.其中左肺下叶切除6例、左全肺切除4例、右肺中下叶切除6例、右肺下叶切除3例、右全肺切除2例.结果:21例均手术顺利;术后并发心律失常2例,肺炎2例,均治愈.本组1年生存率61.9%(13/21)、3年生存率38.1%(8/21),其中2例生存＞5 a.结论:晚期肺癌累及肺静脉根部或左心房时,通过切开心包处理肺静脉或同时切除部分左心房可提高肿瘤的根治率.     

心包内处理血管的全肺切除术治疗肺癌24例

近年来肺癌发病率逐年增加，肺癌在其自然的生长过程中侵犯各级肺血管很常见，临床上Ⅲ期中心型肺癌增多。对于那些肺门冻结，心包外已无法处理肺血管者，切开心包，在心内处理血管行全肺切除术，对于心肺功能尚好的病人仍能达到根治性治疗的目的，手术的安全性亦好。自1989年2月至2003年10月，我科采用全肺切除手术治疗肺癌86例，其中24例经心包内处理肺血管后行全肺切除术，术后疗效满意，现结合病案分析报告如下。     

血管外科技术在晚期肺癌手术中的应用

目的总结血管外科技术在肺癌晚期侵及胸部大血管治疗过程中的临床应用及疗效。方法回顾1999年1月至2005年12月。118例肺癌患者因肿瘤侵及胸部大血管而行血管成形或重建术。结果肿瘤完全切除90例，不完全切除24例；肿瘤未切除仅行左无名静脉与右心耳搭桥术4例。左上叶肺癌侵及肺动脉袖状切除14例，肺动脉部分切除52例；右上肺动脉袖状切除2例。肺动脉部分切除12例。左肺下叶中心型肺癌侵及左心房行左心房部分切除6例，右下肺癌侵及左心房行心房部分切除17例。右上肺癌或转移淋巴结侵及上腔静脉行上腔静脉置换或部分切除修补术15例（7例上腔静脉置换，8例部分切除）。全组无术中死亡，术后并发症发生12例，死亡9例。结论运用血管外科技术，肺癌切除并进行大血管成型或重建，可提高患者手术切除率。     

肺癌全肺切除172例临床分析

目的总结全肺切除治疗中晚期肺癌的临床结果,探讨心包内处理肺血管的适应证和手术要点。方法对172例肺癌全肺切除患者进行回顾性分析,左全肺切除135例,右全肺切除37例,其中38例行心包内处理肺血管全肺切除。结果围术期内死亡2例,术后并发症发生率28.48%,随访1、3、5年生存率分别为74.68%、32.02%、21.94%。结论心包内处理肺血管安全可行,全肺切除术可提高手术切除率,是治疗中晚期肺癌的一种有效术式。     

心包内处理血管在全肺切除术中的应用

目的探讨心包内处理肺血管全肺切除治疗中心型肺癌的临床效果及并发症的防治。方法回顾性分析心包内处理血管的全肺切除术的32例中心型肺癌的临床资料。结果全组32例术后1、3、5年生存率分别为93.8%、31.3%、21.9%,主要并发症发生率为43.4%。结论心包内处理血管的全肺切除是一种安全可靠的手术方式,可提高肺癌切除率及术后生存率。     

微创肌肉非损伤性开胸治疗肺癌的探讨

目的 探索肌肉非损伤性开胸术作为肺癌手术的常规切口。方法 自2001年3月至2003年4月连续对93例临床上怀疑或确诊为肺癌的患，应用肌肉非损伤性开胸方法作为胸部手术的常规切口。共行肺切除术89例，右上肺叶切除22例(其中袖式切除2例)，右中下肺叶切除11例(其中心包内处理肺静脉2例)，右中叶切除3例，右下肺叶切除12例，右全肺切除3例(其中心包内处理肺动脉l例)，左上肺叶切除11例(其中加胸壁大块切除l例)，左下肺叶切除12例(其中加胸壁大块切除l例)，左全肺切除6例(其中心包内处理肺动脉l例)，楔形切除9例。术前确诊为肺癌和术中冰冻病理证实为肺癌及高度怀疑为肺癌的，均行肺门、隆突及纵隔淋巴结清扫。结果 这种切口基本可以满足这些手术的需要，无围手术期死亡，未出现严重并发症。结论 肌肉非损伤性开胸术操作简便，并不会因为手术中暴露不足而影响手术的彻底性，可以作为肺癌手术的常规开胸切口。     

CT引导经皮肺穿刺种植放射性粒子治疗肺癌的疗效观察

临床确诊的肺癌患者多为晚期，治疗效果差。一部分周围型肺癌患者因局部组织侵犯或远处转移，或因心脑肺等重要器官损害无法接受手术切除治疗，因此癌组织间近距离放射治疗肺癌有可能成为治疗的方法之一。2007年始，本文采用CT导向下经皮肺穿刺在瘤体内永久性植入^125I粒子治疗肺癌10例，近期疗效满意，报道如下。     

肺静脉异常一例

解剖一成年男性标本时,见右肺静脉有三支.该标本的心脏大小、外形.左、右肺的外形及肺裂均无异常.察看出人心的大血管.见肺动脉较粗.左肺动脉直径24mm;右肺动脉直径21mm,肺静脉共有五支.左肺静脉2支,上支直径15.5mm.下支直径15mm.右肺静脉三支,其中两支较粗大,上支直径16mm,下支直径13mm,第三支较为细小.直径5.4mm,来自右肺上叶,注入左心房后上部,距右肺上、下静脉注入左心房的入口约10mm.实属罕见.此种肺静脉异常,在肺手术时应加以注意.     

正常引流肺静脉解剖变异的多层螺旋CT血管成像研究

目的 探讨正常引流肺静脉的解剖变异率及其变异形式。方法 回顾性分析2013年5月—2014年7月中山大学附属孙逸仙纪念医院220例两侧肺静脉均引流至左心房患者的胸部64层螺旋CT血管成像(MSCTA)资料,对肺静脉进行多平面重建(MPR)、最大强度投影(MIP)及VR重建,观察段以上肺静脉引流区域,以及双侧肺静脉与左心房连接模式。两侧肺静脉分别以上、下肺静脉独立开口于左房,右中叶肺静脉回流至上肺静脉者为正常肺静脉引流模式;一侧单支或多于两支肺静脉引流、跨叶引流者为肺静脉解剖变异。结果 220例正常引流肺静脉中,左右肺静脉总变异发生率22.7%(50/220)。右肺静脉解剖变异38例(17.3%,38/220),共见8种变异模式,分别为:(1)上、下叶肺静脉分别汇入左心房,中叶静脉汇入下叶肺静脉 4例(1.8%,4/220);(2)上、下叶肺静脉分别汇入左心房,上叶后段汇入下叶肺静脉2例(0.9%,2/220);(3)上、中、下叶静脉分别汇入左心房16例(7.3%,16/220);(4)上叶后段、尖前段、下叶肺静脉分别汇入左心房,中叶静脉汇入尖前段肺静脉4例(1.8%,4/220);(5)上叶、下叶背段、下叶基底段肺静脉分别汇入左心房,中叶静脉汇入上叶肺静脉2例(0.9%,2/220);(6)上叶、 中叶内段、中叶外段、下叶肺分别静脉汇入左心房6例(2.7%,6/220);(7)上叶后段、上叶尖前段、中叶、下叶肺静脉分别汇入左心房2例(0.9%,2/220);(8)上叶、中叶、下叶背段、下叶基底段肺静脉分别汇入左心房2例(0.9%,2/220)。左肺静脉变异12例(5.5%,12/220),共见2种变异模式,即上、下叶肺静脉组成共干汇入左心房8例(3.6%,8/220),上叶、舌叶、下叶肺静脉分别汇入左心房4例(1.8%,4/220)。220例患者中,左右肺静脉解剖变异率的差异有统计学意义(χ²＝13.533, P<0.01)。结论 MSCTA上正常引流肺静脉解剖变异常见,右肺静脉解剖变异发生率显著高于左肺静脉,且变异模式多样。     

三维CT血管造影在右肺上叶静脉解剖中的应用

目的　应用多层螺旋CT血管造影（MSCTA）联合后处理容积重建（VR）技术显示右肺上叶静脉,对其解剖结构进行分类。 方法　95例患者行肺动静脉造影,应用VR技术显示右肺上叶静脉,研究其分支类型及引流静脉归类概况。 结果　（1）右肺上叶前静脉有多支,95例患者共268支,走形复杂,主要收集右肺上叶前段和尖段血液,有18例走形于右肺水平裂,收集右肺上叶前段和右肺中叶的血液;右肺中央静脉为1支,共95支,走形于右肺上叶前段和尖段支气管中间;右肺上叶后静脉较少出现,共14支,其中5支直接汇入左心房。（2）右肺上叶肺静脉分型中,“前+中央静脉”型最为常见,有81例（85.2 %）,“前+中+后静脉”型14例（14.8%）,单纯的“前静脉”型和“中央静脉”型本研究未发现。 结论　MSCTA联合后处理VR技术可以真实直观地显示右肺上叶静脉的分支形式。     

Late results of the combined treatment with the use of preoperative chemotherapy and surgery of locally advanced non-small cell lung cancer

The aim of the study is the assessment of efficacy of combined treatment (preoperative chemotherapy and surgery) of locally advanced non-small cell lung cancer. Material included sixty-two NSCLC patients treated in the Department of Thoracic Surgery of Medical School of Lublin between February 1993 and October 1997. Treatment was started with 2 or 3 courses of chemotherapy. In 51 cases chemotherapy was based on Cisplatin. Response (CR + PR) to chemotherapy was observed in 30 cases (48.8%). 21-25 days after last course of chemotherapy resections were carried out. In 1 case it was lobectomy, in 25 cases--pneumonectomy and in 36--extended pneumonectomy. In 56 cases resection was radical, in 6 cases non-radical. No perioperative deaths or bronchial fistulas were observed. Median survival was 21.4 months and 5-years survival--35.25%. The results confirm the usefulness of preoperative chemotherapy in locally advanced NSCLC.     

Surgical resection of recurrent lung cancer in patients following curative resection

We reviewed our experience with resection of recurrent lung cancer to evaluate the benefit and risk of the procedure. From December 1994 to December 2003, 29 consecutive patients underwent pulmonary resections for recurrent lung cancer. The mean duration from the first resection to second surgery was 25.4+/-15.1 months for the definite 2nd primary lung cancer (n=20) and 8.9+/-5.7 months for metastatic lung cancer (n=9). The procedures at the second operations were completion-pneumonectomy in 11 patients, lobectomy in 5 patients, wedge resection in 12 patients and resection and anastomosis of trachea in 1 patient. Morbidity was observed in 6 (21%) of the patients and the in-hospital mortality was two patients (7%) after the repeated lung resection. Tumor recurrence after reoperation was observed in 14 patients (48%). The actuarial 5-yr survival rate was 69% and the 5-yr disease free rate following reoperation was 44%. No significant difference was found in overall survival and disease free survival between the 2nd primary lung cancer group and the metastatic lung cancer group. The recurrence rate following reoperation was significantly different between the wedge resection group and lobectomy/completion pneumonectomy group (p=0.008), but the survival rate was not significantly different (p=0.41). Surgical intervention for recurrent lung cancers can be performed with acceptable mortality and morbidity. If tolerable, completion pneumonectomy or lobectomy is recommended for resection of recurrent lung cancer.     

The impact of the sequence of pulmonary vessel ligation during anatomic resection for lung cancer on long-term survival – a prospective randomized trial

PurposeThe aim of this prospective randomized trial was to assess the influence of the sequence of pulmonary vessel ligation, during anatomic resection, on long term survival in patients with NSCLC.Material/MethodsThis prospective randomized study included 385 patients treated surgically with lobectomy or pneumonectomy and standard lymphadenectomy between 1999 and 2003. Patients were randomly assigned to either primary ligation of the pulmonary artery or arteries (group A – 215 patients) or of the pulmonary vein or veins (group V – 170 patients). Patients were excluded if the sequence of vessel ligation was affected by technical difficulties or anatomic limitations. Univariate and multivariate analyses included: the sequence of vessel ligation, age, gender, tumor histology, stage (TNM), and cause of death (cancer related or non-cancer related).ResultsMedian follow-up was 63 months. The groups were comparable regarding gender, histology, type of resection, and T, N, and overall stage. Overall, 5-year survival reached 50% in group A and 54% in group V (p = 0.82) and did not differ significantly in cancer related and non-cancer related deaths (p = 0.67 and p = 0.26, respectively). Univariate analysis identified higher T and N factors, advanced stage, pneumonectomy, male sex, and older age as negative prognostic factors. Multivariate analysis demonstrated that age, T3–4 disease, and nodal involvement were associated with inferior survival.ConclusionsThe sequence of pulmonary vessel ligation during anatomic resection for non-small cell lung cancer does not significantly affect long-term survival.     

肺动脉切除重建术的应用解剖学

目的:为肺动脉切除与重建提供解剖学基础。方法:选择肺内结节性病灶,直径<3.0cm的周围型肺癌或良性球灶,接受肺叶切除手术的病人,对其肺动脉心包外段的长度、外径、分支及奇静脉各段的长度、外径进行观测。结果:左、右肺动脉出心包返折处至下叶背支动脉起点处的长度分别约为45.7mm、42.8mm;动脉起点处的外径:左侧分别为20.6mm、12.6mm,右侧分别为21.5mm、14.7mm。奇静脉可利用的第1段(奇静脉弓)和第2段的长度分别为44.8mm、46.8mm,第1段两端的外径分别为12.7mm、12.3mm。结论:肿瘤侵犯肺动脉主干及其分支根部,动脉切除后可采用侧壁扩大及袖式吻合重建术。肺动脉侧壁切除缺损较大时,右侧可首选自体奇静脉片;左侧首选心包片进行重建。     

外科治疗非小细胞肺癌280例临床分析

目的探索不同的外科手术切除方式治疗非小细胞癌的安全性和远期疗效。方法选取我院2002年1月至2007年1月手术治疗的280例非小细胞癌患者,其中全肺切除组180例,肺叶袖状切除组100例,将两种手术方式治疗的术后并发症发生率、死亡率以及5年生存率进行比较分析。结果全肺切除后并发症发生率21.1%,袖状切除后并发症发生率10.9%,两组差异有统计学意义（P〈0.05）;全肺切除后死亡率3.9%,袖状切除后死亡率3.0%,两组差异无统计学意义（P〉0.05）;全肺切除5年生存率30.2%,袖状切除44.3%,组间差异有统计学意义（P〈0.05）,其中N0、N1分型患者5年生存率袖状切除优于全肺切除（P〈0.05）,N2型患者5年生存率两组差异无统计学意义（P〉0.05）。两组患者的术后复发率差异无统计学意义（P〉0.05）。结论对非小细胞癌的治疗,采用肺叶袖状切除的总体治疗效果要优于全肺切除术。